Search

Intraoral lesions, abnormalities on the tongue or tissues in the mouth and throat, caused by infections have been associated with AIDS and HIV infection from the early stages of the epidemic. Increasingly, HIV disease is being defined by CD4+ and CD8+ T lymphocyte counts. This study examined if there is a relation between T lymphocyte counts and intraoral lesions. HIV-infected individuals, enrolled in a drug study, underwent oral examinations between January and December 1989. Up to four examinations were performed during the study period. T lymphocyte counts were averaged for a given time frame covering a period just prior to the first examination, and for later examinations, for a period between the prior and present examination. A total of 106 patients participated in the study and were examined at least once. Of the 106 participants, 88 percent participated in the second examination, 72 percent in the third, and 56 percent in the fourth. Oral lesions were seen in 38 patients (36 percent) at some point during the study. CD4+ and CD8+ counts did not differ significantly for patients who did not have lesions and those who did. At the first examination, oral lesions were seen in 25 percent of the patients. For subsequent examinations, the rates were 19, 15, and 20 percent. The most commonly seen lesions were ulcerative lesions and hairy leukoplakia. CD4+ counts were stable until after examination 4. CD8+ counts increased slightly by examination 4. When data on T lymphocyte counts performed before and after the examinations were compared with examination results, a relation was found between an elevated CD8+ count before the examination and the presence of an oral lesion at the examination. This relationship remained unchanged when smoking and alcohol use were considered. These results indicate that information on changes in CD8+ counts may be useful for preventing or managing HIV-related oral lesions. (Consumer Summary produced by Reliance Medical Information, Inc.)

The incidence of infection following joint replacement surgery is about 1 percent. The amount of illness caused by these infections is substantial, and when patients have developed infections caused by spread of bacteria via the blood stream from other locations in the body, the mortality rate has approached 18 percent. There have been some reports of joint replacement infection from bacteremia (bacterial infection in the blood) caused by dental work. A survey of orthopedic surgeons revealed that 57 percent did not believe that there was a strong relationship between the transient bacteremia caused by dental work and development of secondary infection of artificial joints. Surprisingly though, 93 percent of the responding orthopedists recommended preventive antibiotic administration prior to dental work in patients with a joint replacement. Despite the fact that penicillin is the antibiotic considered to be most effective against bacteria in the mouth, only 13 percent recommended its use (70 percent recommended cephalosporin). Transient bacteremias occur within minutes of the dental procedure and last up to 30 minutes; therefore prolonged antibiotic use is unnecessary. The authors believe the need for antibiotic prophylaxis before dental procedures to prevent infection in the area of an artificial joint has not been established. But until further research is performed, they recommend that joint arthroplasty patients be given penicillin V one hour before dental procedures and another dose six hours later. If the patient cannot take penicillin, erythromycin may be given. Other sources of bacteremia may be caused by different types of bacteria, and these will require the appropriate antibiotic. (Consumer Summary produced by Reliance Medical Information, Inc.)